Pediatric cytomegalovirus infections

Abstract

Cytomegalovirus (CMV) is a frequent infection, which is usually asymptomatic however, infection of the fetus in utero, can cause severe disease and death. Premature and young infants, immunosuppressed children who receive transplants and children with human immunodeficiency virus (HIV) infection are also at risk for significant disease due to CMV. The diagnosis of infection in pregnant women and children requires the use of serology and/or detection of the virus. Serological tests are available for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody however, these tests have important limitations. The virus can be detected by tissue culture using the shell vial and centrifugation method or by identification of CMV deoxyribonucleic acid (DNA) or messenger ribonucleic acid (mRNA). These tests also have some limitations. Additional laboratory tests have been reported to improve the accuracy of diagnosis but require further evaluation. Treatment with ganciclovir or foscarnet may be beneficial. Approaches to prevention of infections associated with transfusions include the use of CMV-IgG antibody negative blood or leukoreduction. Recipients of stem cell transplants can also be given high titered antibody to CMV. Children with HIV and severe immunosuppression can now receive highly active retroviral therapy, which may reduce the immunosuppression and the risk for CMV disease.